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PAGI
Respiratory Failure
A respiratory rate of less than 10 or greater than 60 is
an ominous sign of impending respiratory failure in
children.
Breathing
Breathing is assessed to determine the childs ability
to oxygenate.
Assessment:
Respiratory rate
Respiratory effort
Breath sounds
Skin color
Airway
Airway must be clear and patent for successful ventilation.
Position
Suction
Administration of oxygen
Bag-mask ventilation
Heart rate greater than 140 beats per minute at rest needs to be
evaluated.
Blood Pressure
25% of blood volume must be lost before a drop in
blood pressure occurs.
Neonates: < 60 mm Hg
Infants: <70 mm Hg
Child (1 to 10): < 70 mm Hg
Child (>10): < 90 mm Hg
Stages of Shock
A progressive process: Intervene early
Compensated Shock: Cardiac output
(HR x SV) and systemic vascular resistance (peripheral vasoconstriction) work to keep BP
within normal.
On exam: Tachycardia; decreased pulses & cool extremities in cold shock; flushing and bounding pulses
in warm shock; oliguria; labs may show mild lactic acidosis
Obstructive Shock
Distributive Shock Outflow from left or right
Decrease in SVR, with side of heart physically
abnormal distribution of obstructed.
blood flow functional
hypovolemia,
decreased preload.
Typically, NL or CO.
Physiologic profiles of shock states
Type of Shock Preload Cardiac Afterload Tissue
(PCWP) Output (SVR) Perfusion
(Mixed venous sat)
Hypovolemic
Distributive Or = Or =
Cardiogenic *
Obstructive
Shock: General initial management
PICU consult?
Rapid Response? (if available)
Pediatric Code Blue (Code White)?
Remember:
It is better to de-escalate a Code than emergently escalate a PICU
consult/Rapid Response.
General initial management
Overall goal: Normalization of BP and tissue
perfusion.